autonomy

Introduction

• delivery of care based upon the patient's values & preferences, i.e. respecting a patient's right to determine his/her destiny & pursuit of his/her beliefs & happiness
• it implies that the patient is capable of making reasonable decisions, including the right to refuse therapy (even at the risk of death). (see competence)
• advance directives are widely believed to be a safeguard the autonomy of patients who lose decision-making capacity.

*From the Greek for 'self rule'

• 0ne exception to the rule of autonomy is emergency treatment.
  • if emergency treatment for a critically ill & incapacitated patient is likely to produce substantial benefit & if delaying treatment is likely to lead to irreversible harm, emergency treatment without consent is widely accepted
  • however, this exception is limited when the patient has previously expressed a desire not to undergo the proposed medical intervention
  • a do not resuscitate (DNR) order is acceptable when the patient has clearly stated in advance this desire

• a 2nd major exception to the rule of autonomy is called 'therapeutic privilage'.
  • in this case, a physician or the patient's family may believe that fully informing a patient about his/her medical condition may do more harm than good
  • some patients may prefer not to know if they are terminally ill & ask that family members or other caregivers receive all diagnostic information & make treatment decisions
  • this practice is not widely accepted in the United States, but is widely accepted in most other cultures

Management

• ask the patient about their preference for disclosure & participation in medicial decisions (preferable as a part of advance directives)
• if the family requests a patient should not be informed of a serious or terminal diagnosis, ask the family their reason for withholding the diagnosis

More general terms

• medical ethics

Additional terms

• advance directives
• competence
• do not resuscitate (DNR); do not attempt rescuscitation (DNAR)